Mina Awadallah, MD, MSc1, Rebecca G. Kim, MD, MAS2, John Erikson Yap, MD, MBA, FACG2, Charles H. Wang, MD1, Juan F. Gallegos-Orozco, MD, FACG2 1University of Utah, Salt Lake City, UT; 2University of Utah Health, Salt Lake City, UT Introduction: Chronic lymphocytic leukemia/small lymphocytic lymphoma(CLL/SLL)is the most common indolent B-cell malignancy, with hepatic involvement generally considered rare and often subclinical.While CLL/SLL may involve the liver histologically, clinically significant hepatic infiltration is uncommon.We present a unique case of a patient with metabolic dysfunction-associated steatohepatitis (MASH) cirrhosis and hepatocellular carcinoma (HCC) who underwent liver transplantation, with the explant unexpectedly revealing extensive infiltration by CLL/SLL.
Case Description/
Methods: A 67-year-old male presented with MASH cirrhosis complicated by early-stage HCC(Barcelona Clinic Liver Cancer Stage A),treated with Yttrium--90 radioembolization. During staging workup for HCC in September 2023, he was found to have mild mesenteric lymphadenopathy.He then underwent lymph node resection and was incidentally diagnosed with CLL/SLL.After consultation with hematology/oncology, the indolent disease was not considered to be a barrier to transplant. Therefore, we proceeded with listing with the plan to monitor with annual imaging post-transplant.The patient successfully underwent liver transplantation.Pathologic examination of the explant revealed cirrhosis with unexpectedly extensive infiltration of CLL/SLL, predominantly involving fibrous septa and sinusoids, without parenchymal infiltration.This degree of hepatic involvement has not been previously encountered in our experience and appears rarely documented in the literature. Discussion: This case highlights a rare presentation of extensive hepatic involvement by CLL/SLL discovered incidentally at the time of liver transplantation.While the patient had established risk factors for MASH-related cirrhosis, the pattern and degree of CLL/SLL infiltration raise questions about its possible contribution to liver disease progression.Importantly,CLL/SLL involvement was confined to fibrous tissue, and its clinical implications for graft health remain uncertain.Given the lack of precedent for such findings, this case prompts discussion regarding appropriate post-transplant immunosuppression, surveillance strategies, and the need for multidisciplinary coordination.Future imaging will play a key role in monitoring for progression.This case underscores the importance of thorough explant evaluation and suggests the need for heightened awareness of rare CLL/SLL presentations in patients undergoing liver transplantation.
Figure: Figure 1. Diffusely nodular liver with infiltration of fibrous bands and parenchyma by CLL/SLL.
Figure: Figure 2. CLL/SLL with extensive involvement of a cirrhotic liver, expanding internodular fibrous bands and infiltrating the sinusoids. The cells are positive for CD5.
Disclosures: Mina Awadallah indicated no relevant financial relationships. Rebecca Kim indicated no relevant financial relationships. John Erikson Yap: Phathom Pharmaceutical – Speakers Bureau. Steris – Consultant. Charles Wang indicated no relevant financial relationships. Juan Gallegos-Orozco: Gilead – Grant/Research Support. Hanmi – Grant/Research Support. Intercept – Grant/Research Support. Mirum – Grant/Research Support.
Mina Awadallah, MD, MSc1, Rebecca G. Kim, MD, MAS2, John Erikson Yap, MD, MBA, FACG2, Charles H. Wang, MD1, Juan F. Gallegos-Orozco, MD, FACG2. P6150 - Unexpected Extensive Hepatic Infiltration by CLL/SLL in a Liver Explant: A Rare and Incidental Finding at Transplantation, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
